Healthcare Provider Details

I. General information

NPI: 1003013939
Provider Name (Legal Business Name): LONGS DRUG STORES CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 WAIALAE AVE
HONOLULU HI
96816-5842
US

IV. Provider business mailing address

141 N CIVIC DR
WALNUT CREEK CA
94596-3815
US

V. Phone/Fax

Practice location:
  • Phone: 808-735-2811
  • Fax: 808-735-1794
Mailing address:
  • Phone: 925-210-6659
  • Fax: 925-210-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number562050
License Number StateHI

VIII. Authorized Official

Name: AMY M HALLIDAY
Title or Position: MANAGED CARE ADMINISTRATOR
Credential:
Phone: 925-210-6659